There is increasing attention given to academic integrity across university education and dental schools are not immune to this problem (Andrews et al. J Dent Educ 71; 1027-1039, 2007; Ford & Hughes Eur J Dent Educ 16(1):e180-e186, 2012). While there has been an increasing concern about academic dishonesty in written exams and assignments, there appears to be a false sense of security in the integrity of practical assessments, involving dental procedures on simulated patients. This paper will present a situational analysis of two unusual cases of academic dishonesty in preclinical dental practical assessments. The first case involved a student bringing a previously prepared plastic tooth into the examination room and substituting it for the assessment tooth. The second case involved a student removing key teeth during the exam to enable them to have better access and advantage over others to complete the assessment task. These two cases resulted in a complete review of practical assessment procedures and the application of new processes to maintain academic integrity.